A total laparoscopic treatment strategy for Amyand's hernia complicated with appendicitis: A case report

Two cases of intraoperative diagnosed Amyand hernia: Case report and literature review

INTRODUCTION

Amyand hernia is the presence of an incarcerated vermiform appendix (either inflamed or not) within the hernia sac. This type of hernia is very rare with an incidence reported to be 0.5 to 1 % and even rarer in adults.

CASES PRESENTATION

We present here two cases of male patients found the have an Amyand Hernia diagnosed incidentally intraoperatively, and managed with appendectomy and mesh herniorrhaphy.

CLINICAL DISCUSSION

For the management of this type of hernia, in general, the surgeon should perform an appendectomy with the repair to prevent future herniation or appendicitis, but some opinions differ, and state that when there are no signs of inflammation, it is not required to perform a preventative appendectomy.

CONCLUSION

The decision on how to manage depends on multiple factors including inflammation of the appendix, the possibility of abdominal sepsis, and the patient comorbidities. The status of the appendix determines whether to undergo hernia repair with or without mesh.

Controversies Regarding Mesh Utilisation and the Attitude towards the Appendix in Amyand's Hernia-A Systematic Review

Inguinal hernia containing the vermiform appendix is a rare entity. It is more common in children than in adults. It can be discovered incidentally during the surgical intervention performed for the cure of the inguinal hernia or when the appendix shows inflammatory changes, a situation that can lead to diagnostic confusion with a number of other diseases. Imaging can guide the diagnosis, which often comes as an intraoperative surprise. The therapeutic approach is controversial both in terms of whether or not to perform an appendectomy in the case of an appendix without inflammatory changes and especially in terms of using a mesh during the hernia repair process. Since the pathology is not very frequent, there are no standardized stages in terms of surgical ethics that can guarantee good surgical practice. The study aimed to carry out a review of the specialized literature to obtain some conclusions or trends regarding the management of this pathology. The low frequency of this type of hernia did not allow the consultation of large-scale studies or extensive reviews focusing on case reports or case series communications. The obtained results were statistically analyzed and integrated in relation to the surgical attitude depending on the particularities of the condition.

Amyand's Hernia: A Radiological Solution of a Surgical Dilemma

Amyand's hernia is a rare condition whereby the appendix lies within the sac of an inguinal hernia; rarer still, the appendix can become inflamed (acute appendicitis) and is frequently misdiagnosed as a strangulated inguinal hernia. We report a case of Amyand's hernia complicated with acute appendicitis. In this case an accurate preoperative diagnosis was provided by a preoperative Computerised Tomography (CT) scan, permitting planning of treatment by a laparoscopic approach.

SAFETY OF SIMULTANEOUS LAPAROSCOPIC APPENDECTOMY IN COMBINATION WITH LAPAROSCOPIC HERNIA REPAIR (TAPP). A SERIES OF CLINICAL CASES

Aim: To evaluate the technical feasibility and safety of a simultaneous surgery: laparoscopic appendectomy in combination with transabdominal preperitoneal hernia repair.

Methods: The study was a retrospective analytical one. The medical histories were studied and postoperative monitoring of eleven patients hospitalized with acute appendicitis who underwent simultaneous surgery: laparoscopic appendectomy with simultaneous laparoscopic plastic surgery of clinically significant inguinal hernia was carried out. During the statistical analysis, the following parameters were evaluated: the timing of postoperative recovery, the frequency of early postoperative complications and the frequency of recurrence of inguinal hernia a year after surgery.

Results: The surgery was successfully performed in all 11 patients. There were no cases of infectious complications of the surgical intervention area. Acute urinary retention was registered in one patient in the early postoperative period. In one case, an early adhesive intestinal obstruction was diagnosed, which was resolved with conservative treatment. There were no cases of recurrent inguinal hernia during the year.

Conclusion: laparoscopic appendectomy in combination with transabdominal preperitoneal hernia repair can be used in the treatment of acute appendicitis in combination with inguinal hernia in the absence of signs of gangrenous appendicitis with purulent peritonitis. The low statistical power of the study does not allow us to draw conclusions about the safety of this approach for patients of the older age group with a high comorbidity index.

Amyand's hernia complicated with appendicitis: an interval approach with transabdominal laparoscopic appendectomy and laparoscopic hernioplasty-a case report

Amyand's hernia is a rare classification of inguinal hernia where the vermiform appendix is located within the hernial sac. This case report discusses a patient presenting with abdominal and groin pain shown to be an Amyand's hernia complicated by acute appendicitis on computed tomography. The patient was treated with a two-stage approach, involving transabdominal laparoscopic appendectomy and elective laparoscopic hernioplasty after recovery. As some controversy exists regarding the timing of appendectomy and hernioplasty, we examine the benefits of the interval approach in the reduction of postoperative infection risk compared with a concurrent approach in patients presenting with Amyand's hernia complicated by appendiceal inflammation.